Zhang Chenge, Tian Wenfang, Zhou Xiaofang, Li Lesai, Tan Shanmei, Sun Lijuan, Tang Jie
Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine Central, South University/Hunan Cancer Hospital, Changsha, People's Republic of China.
Department of Gynecology and Obstetrics, Hengyang Medical School, Graduate Collaborative Training base of Hunan Cancer Hospital, University of South China, Hengyang, People's Republic of China.
Ann Surg Oncol. 2025 Mar;32(3):2213-2222. doi: 10.1245/s10434-024-16637-3. Epub 2024 Dec 29.
The aim of this retrospective study was to evaluate the outcomes of laparoscopic radical hysterectomy (LRH) for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1 IB1 patients with low-risk cervical cancer (CC), which was defined as tumor ≤ 2cm, less than 1/2 stromal invasion and no lymph node involvement.
We performed a retrospective analysis of patients with CC who underwent radical hysterectomy across three hospitals between 2010 and 2020. The patients were stratified into low-risk and high-risk groups based on risk factors (tumor size, lymph nodes and stromal invasion depth). Within each group, the survival outcomes of open abdominal radical hysterectomy (OARH) and LRH were compared using the Kaplan-Meier analysis.
In the low-risk group (LRH: N = 320; OARH: N = 525), LRH demonstrated equivalence to OARH regarding 5-year overall survival (OS; 98.6% versus 99.3%, P = 0.571) and 5-year progression-free survival (PFS; 97.6% versus 98.4%, P = 0.418). Subsequently, a stratified analysis based on lymphovascular space invasion (LVSI) status revealed no significant differences in 5-year OS and PFS between LRH and OARH in this group. Conversely, in the high-risk group (LRH: N = 355; OARH: N = 926), LRH exhibited significantly lower 5-year OS and PFS than OARH (91.3% versus 94.8%, P = 0.049; 84.0% versus 88.8%, P = 0.029).
Among FIGO 2018 stage IA1-IB1 patients with low-risk CC, LRH demonstrates survival outcomes comparable to OARH. For patients with early-stage and low-risk CC, the appropriate surgical approach (LRH) can be chosen based on preoperative enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) MRI, which is clinically feasible.
本回顾性研究旨在评估国际妇产科联盟（FIGO）2018年IA1期和IB1期低风险宫颈癌（CC）患者行腹腔镜根治性子宫切除术（LRH）的疗效，低风险宫颈癌定义为肿瘤≤2cm、间质浸润小于1/2且无淋巴结转移。
我们对2010年至2020年间在三家医院接受根治性子宫切除术的CC患者进行了回顾性分析。根据危险因素（肿瘤大小、淋巴结和间质浸润深度）将患者分为低风险组和高风险组。在每组中，采用Kaplan-Meier分析比较开腹根治性子宫切除术（OARH）和LRH的生存结局。
在低风险组（LRH：N = 320；OARH：N = 525）中，LRH在5年总生存率（OS；98.6%对99.3%，P = 0.571）和5年无进展生存率（PFS；97.6%对98.4%，P = 0.418）方面与OARH相当。随后，基于淋巴血管间隙浸润（LVSI）状态的分层分析显示，该组中LRH和OARH的5年OS和PFS无显著差异。相反，在高风险组（LRH：N = 355；OARH：N = 926）中，LRH的5年OS和PFS显著低于OARH（91.3%对94.8%，P = 0.049；84.0%对88.8%，P = 0.029）。
在FIGO 2018年IA1 - IB1期低风险CC患者中，LRH的生存结局与OARH相当。对于早期低风险CC患者，可根据术前增强磁共振成像（MRI）和扩散加权成像（DWI）MRI选择合适的手术方式（LRH），这在临床上是可行的。
